Drugs that may increase BP are
- Oral contraceptives
- appetite suppressants
- Some SSRI's -Effexor, and zoloft
2nd Stage HTN
DASH diet lifestyle modification for HTN
Can reduce SBP by _____?
- Diet rich in fruits, vegetables, and low fat dairy.
- Reduce saturated and total fat.
- Can reduce SBP by 8-20 mmHg
Renin inhibitors for controlling HTN
- Do not decrease Renin!!!
- Increase Renin but inhibit the ability of angiotensin I (vasoconstriction)
mediates ECF volume and arterial constriction
DOC for HTN and pregnancy
BB not as effective for treatment in HTN in African Americans as ______?
_____% of HTN is idopathic
May not be able to identify cause
Clinical Evaluation of patients with HTN!!
Continually ______ and _______ treatment!!
monitor and modify
Central acting alpha agonist such as clonidine and methyldopa act through stimulation of ?
central inhibitory alpha adrenergic receptors
- THIS INHIBITS THE SYMPATHETIC NERVOUS SYSTEM
- ( INHIBITS CARDIOACCELERATION AND VASOCONTRICTOR CENTERS)
- Result in decreased PVR, HR, and BP
DOC for stage I and II HTN
- Stage one - for most
- Stage 2- Thiazide with another medication (ACEI or ARB, BB, or CCB)
- Increase urinary excretion of sodium and chloride in equal amounts.
- Inhibit reabsorption of Na and CL in ascending limb of loop of Henle.
- Increases K+ and bicarbonate excretion and decrease Ca+ excretion.
Thiazides increase _______ retention, which may cause ________?
- uric acid retention
May not want to use thiazides in ______ adults with ______ kidney function because it can cause _______?
Thiazide diuretics and loop diuretics contradicted with patients with _______ allergy
or with decreased renal function
ADR of thiazide diuretics
- electrolyte imbalance
- hypokalemia, hypomagnesemia
- hypercalcemia, hyperuricemia, hyperglycemia.
Diuretics are feared with diabetics because they cause_____
hyperlipidemia due to increased insulin resistance.
Dosage of Thiazide Diuretics
- 12.5 mg to 100 mg per day
- Don't have them take at night, they will be up all night going to bathroom
- -can cause cramping.
- Don't use high doses with gout, hyperlipidemia, and diabetes
# 1 thing to monitor with patient on diuretics!!
What is the most common form of target organ damage associated with HTN
Ischemic heart disease
Kidney is second
DOC HTN and diabetes
What medication is feared in diabetics!!
ACEI and ARBs- seem to work best with diminishing peripheral neuropathies
ALL DIABETICS NEED TO BE ON ACE AND ARB EVEN IF THEY DO NOT HAVE HTN BECAUSE ACEI ARE REANL PROTECTIVE
Diuretics are feared in diabetics, it is feared to cause hyperlipidemia.
What are the most renal protective BP meds
ACEI and ARB's
Stage 2 HTN
Begin combination therapy
Second drug should be......
a drug from another class!!! Two drugs from the same class will not help HTN.
Any unexplained fever with HTN meds always check
Follow up _____ month interval after starting treatment
- more frequent if uncontrolled.
Don't use much because it is short acting and patients have to take it frequently
Use caution with severe coronary insufficiency, conduction disturbances, recent MI, and chronic renal failure
Common adverse effect of Clonidine
Rebound HTN- if abrupt withdrawal
Geriatrics and BP meds
Study showed that BP can be reduced in elderly with low sodium diet and weight loss.
Diuretics and BB are effective in elderly and are shown to reduce morbidity and mortality.